Nurses and healthcare professionals are being exposed to COVID-19 at high rates as they face asymptomatic spread, inadequate testing, and a lack of support following workplace exposure
CANTON, Mass. – As the second surge of the COVID-19 pandemic rocks Massachusetts, the Massachusetts Nurses Association – representing 23,000 nurses and healthcare professionals statewide, including 70% of nurses in acute care hospitals – is calling for the immediate implementation of a universal N95 masking standard to protect staff, patients and the community from asymptomatic spread.
“The state’s rapid increase in COVID-19 cases, high rates of asymptomatic spread, continued inadequacy of healthcare worker testing and the elevated risk of workplace exposure demand that all frontline nurses and healthcare professionals be provided N95 masks,” said Katie Murphy, MNA President and a practicing ICU nurse. “Having an N95 mask is and always has been the scientific standard for caregivers exposed to COVID-19. The federal government weakened PPE guidelines early in the pandemic not because the science changed but due to inadequate supply chains, poor planning, and political expediency.”
Extensive research shows that asymptomatic infections account for as much as 40% to 50% of cases. This includes patients who have not been tested for or suspected of having COVID-19, as well as healthcare staff. Therefore, all nurses and healthcare professionals providing direct patient care or working in high-risk areas (i.e. confined spaces or work requiring significant interactions with variety of people), should receive and wear a new NIOSH-approved N95 respirator mask at the beginning of each shift. For patients that are suspected to have COVID or are COVID positive, nurses and healthcare professionals should have full PPE (gown, gloves, N95 mask and goggles or shield).
A number of additional COVID-19 preparedness and response issues relate to the MNA’s call for universal N95 masking. Read a full statement on those issues here and see highlights below.
PPE Supply Disclosure
The state and many healthcare employers claim N95 masks and other PPE supplies are much improved from the spring surge. Due to inconsistent reporting and an overall lack of transparency, the MNA calls for a publicly disclosed, accurate and accessible accounting of the exact amount of each type of PPE held by every facility and the state. If healthcare facilities do not have adequate supplies to apply a basic minimum standard that sciences show is safe, this should be communicated to nurses and healthcare professionals now – otherwise N95 masking should be implemented universally and immediately.
Enhanced COVID-19 Testing
The MNA is also advocating for improved testing. COVID-19 testing should be done in a readily accessible location for staff. It should be a PCR or equal quality test with results within 24 – 48 hours. Any staff exposed or symptomatic should have access to testing at no cost and they should experience no loss of pay if they must wait for results.
Healthcare Workplace Exposure
Nurses and healthcare professionals are being exposed to COVID-19 at high rates across Massachusetts, including those caring for COVID positive or suspected positive patients and those who are not. Staff are forced to eat and drink in cramped break rooms, interact with visitors and support people who have not been tested, and travel in elevators, escalators, and shuttles without social distancing.
An MGH study observed that “frontline healthcare workers had a nearly 12-times higher risk of testing positive for COVID-19 compared with individuals in the general community.” For these reasons, we advocate for universal N95 masking and pending legislation that would presume healthcare workplace exposure of COVID-19.
Exposure and Return-to-Work
Across the state, MNA nurses and healthcare professionals have learned that immediate family members such as a spouse or child have been exposed to COVID-19 and tested positive. Those caregivers then notified their employer and were told they should report for their next shift in direct patient care roles if they did not have symptoms.
This has been extremely alarming to the nurses, who feared they could also have COVID-19, or could develop it through prolonged exposure to their family members, and spread it to patients or other staff, who could then spread the virus further in the hospital and community. Healthcare employers must follow science and the basic standards of other industries and provide for testing and paid leave for quarantine, if necessary, for exposed nurses and healthcare professionals.
Visitation policies are highly inconsistent across healthcare facilities. Some restrictions similar to the spring surge have been implemented, though enforcement is often lax, leaving it to frontline nurses and healthcare professionals to police visitors rather than hospital administration. In some hospitals, there are excessive numbers of visitors crowding hallways, elevators, nurses’ stations, patient rooms and cafeterias. Limited visitation must also include utilizing trained staff to screen visitors through one entrance with log-in information, masking and no more than 15-minute visits, with follow through by personnel other than nursing if needed.
MNA nurses and healthcare professionals continue to experience crowded shuttles and limited parking availability despite the lessons learned during the first surge. Caregivers must be allowed to social distance to and from work to help reduce the spread. The MNA also recommends a return to onsite parking to avoid cramped transportation as elective cases are severely reduced or cancelled.
Cohorting COVID Patients
Establishing separate areas for COVID-19 positive and suspected patients is part of the Department of Public Health guidelines for healthcare facilities. However, this standard is routinely being flouted by employers across the state. Nurses are being assigned a mix of positive, suspected, or negative patients, and hospital units are being mixed as well. Co-mingling of patients and nurse assignments strains PPE use and results in higher risk of exposure and increased transmission rates for patients and nurses.
Regional field hospital should be up and running, staffed with National Guard personnel. The MNA recommends a central hiring portal be readvertised with the training of industry sectors hard hit (such as hotel industry) as adjunct staff. Patients should be discharged as able to these sites until they are negative and safe to go home. This would maintain necessary capacity within acute care settings.
Healthcare staff should be consulted regarding redeployment training and strategies to best address the second wave and to avoid complete burnout of staff. There should also be additional support services (i.e. behavioral health needs of staff) and enhanced security as the level of violence is increasing with the public centering its frustration on caregivers in emergency departments and other areas.
For more information on the MNA’s positions as well as research and resources regarding the pandemic, visit www.massnurses.org/COVID-19.
Founded in 1903, the Massachusetts Nurses Association is the largest union of registered nurses in the Commonwealth of Massachusetts. Its 23,000 members advance the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Legislature and regulatory agencies on healthcare issues affecting nurses and the public.